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(Message started by: Prense on Jul 10th, 2004, 7:44pm)
Title: Mixing triptans
Post by Prense on Jul 10th, 2004, 7:44pm
I am posting this here just in case there are some who have not been following the other boards.  I know this has been brought up before, but it seems to be time to bring it up again.

This last week, I have read of at least three instances of folks mixing triptans.  Bottom line; it can kill you.

If you are not sure if what you are taking are triptans, look closely at the label, packaging, etc.  If you see anything that has "triptan" in the name, it cannot be taken within 24 hours of another med in the triptan group.

Common ones:
Amerge
Imitrex
Zomig
Maxalt

There are more, and I am sure someone will add to the list later.

Docs know this, and should be passing this info along to their patients.

Happy stabbing!

Chris
Title: Re: Mixing triptans
Post by UN_SOLVED on Jul 10th, 2004, 9:02pm
Great info Chris...
Here's a little more info:
5-HT1 Agonists
Selective
Sumatriptan (Imitrex)
Zolmitriptan (Zomig, Zomig- Rapimelt*)
Naratriptan (Amerge)
Rizatriptan (Maxalt, Maxalt MLT)
Eletriptan (Relpax)
Almotriptan (Axert)
Frovatriptan (Frovaelan)


Nonselective
Ergotamine (Ergomar)
Dihydroergotamine (DHE, DHE 45)


DO NOT MIX THESE
Info atO.U.C.H. (http://www.clusterheadaches.org/library/medications/triptans.htm)

UNSOLVED
Title: Re: Mixing triptans
Post by purpleydog on Jul 10th, 2004, 9:10pm
I appreciate your concern Prense, but  I am under a doctors supervision. And a neurologist too. And they both told me I can use imitrex and maxalt at the same time.  

I'm not sure where you are coming from with this, but all triptans are only available through a prescription. That means you can get them at the pharmacy or samples from your doctor's office. And you can't just waltz in  your doctor's office and pick these up. You have to call them in adavance, which means they pull your chart.  

I am fully aware of the risks of using two triptans and so are my doctors. I choose to use them this way. Sometimes it is the only thing that works. And I am about to find that out again, because it seems that I am starting another cycle and have been hit 3 times since noon today.

I do appreciate your looking out for me.

thanks,

purpleydog
Title: Re: Mixing triptans
Post by Prense on Jul 10th, 2004, 9:26pm

on 07/10/04 at 21:10:17, purpleydog wrote:
I appreciate your concern Prense, but  I am under a doctors supervision. And a neurologist too. And they both told me I can use imitrex and maxalt at the same time.  


Do as you will...

I am coming from trying to keep folks from offing themselves, BTW

Chris
Title: Re: Mixing triptans
Post by broomhilda on Jul 10th, 2004, 9:35pm
Thank you for posting out of concern Chris...wish I knew this months ago when I was taking it all many times a day... no doctor warned me at all, just kept handing out samples...

I think its important to know for new people .....

Hugs
Andrea

PD check your pm's!!! ;;D
Title: Re: Mixing triptans
Post by alleyoop on Jul 10th, 2004, 10:05pm
Thanks Chris,

On the last visit to my neuro, he gave me a bag of mixed samples including among other things-Imitrex(injects & sprays), Zomig sprays and Ergomar(ergotamine) tabs. I was told once by him and twice by the nurse not to mix any one of these three in a 24 hr. period.

During a particularly bad period (K8-9s), trying to conserve my trex injects, I decided to try the Ergomar sublingual tabs. Big Mistake- they didn't do anything and I wound up nuttin out 4 whoppers because I was afraid to switch to the trex or Zomig. Now I figure some one is going to tell me that there's no danger in mixing ergotamine and triptans and my neuro is full of it! I got through it! But if not for so many stern warnings, I would have turned to the trex in a heart beat. I know we're talking about two different animals, but after reading Pupley's post I can't help but wonder.

How can professionals be so far apart on the same thing?

..........................alley [smiley=huh.gif]
Title: Re: Mixing triptans
Post by Prense on Jul 10th, 2004, 10:07pm

on 07/10/04 at 22:05:54, alleyoop wrote:
Now I figure some one is going to tell me that there's no danger in mixing ergotamine and triptans and my neuro is full of it! I got through it!


No, that's true as well...Unsolved provided a good list.

Chris
Title: Re: Mixing triptans
Post by Roxy on Jul 10th, 2004, 10:58pm

on 07/10/04 at 21:26:32, Prense wrote:
Do as you will...

I am coming from trying to keep folks from offing themselves, BTW

Chris


Well, I think everyone knows my position on this subject.  For those who are new....I came as close to killing yourself as you can get in January of this year.  It was totally from mixing triptans.  If I hadn't had someone with me who had the presence of mind to get an ambulance to my side within 5 minutes.....I would be dead.  The doctors told me that.  It took them 15 minutes to get me stable enough to move the ambulance.

I mixed 2mg of imitrex and a 5mg zomig tablet.  That's it.  I had mixed them before without a problem.  It didn't work out so well that time.  When I got to the hospital, I was still going downhill fast.....I just got damn lucky in the end.  It was a total drug interaction......like the cardiologist said..."Same as a heroin overdose".

Don't mix ergotamines with triptans.....and don't mix one triptan with another.  It's not worth the outcome.  I've had many kip 10's, just like everyone here.  I would take a kip 10 over the drug interaction, anyday......no problem.  When you can feel your body shutting down.....the pain of a ch can't compare.

Tracey
Title: Re: Mixing triptans
Post by alleyoop on Jul 10th, 2004, 11:06pm
Thanks Tracy,

That was a sobering post!



........................alley
Title: Re: Mixing triptans
Post by tsayswhy on Jul 11th, 2004, 12:06am
Hello Prense

Seen your post here and had to respond to it. I am one of them last week I was given sansert and imitrex the neurologist told my doctor to put me on this that is was ok because I question it myself. So here’s the thing getting hit every  5-6 hour apart today just started cycle, only do imitrex twice in a 24 hour(all though I’ve been temped to do more). So the rest of them O2 but I remember what happen to Roxy and so I’ve been afraid to start on sansert. But what do you do when we know we shouldn’t mix them and the neurologist says YES. I’ve been questioning it all day whether to start. My head hurt so much today I can’t even think any more. Any advice here would be greatly appreciated
                                                   tari
Title: Re: Mixing triptans
Post by Prense on Jul 11th, 2004, 11:34am
From rxlist.com

Quote:
Drug Interactions
Tell your doctor if you have taken a similar drug (a serotonin receptor agonist) in the last 24 hours. These include:
sumatriptan (IMITREX® )
naratriptan (AMERGE® ) zolmitriptan (ZOMIG® )
rizatriptan (MAXALT® )
or almotriptan (AXERTTM)
have taken ergotamine type medicines in the last 24 hours including: BELLERGAL®; CAFERGOT®; ERGOMAR®; WIGRAINE®; DHE 45®; or SANSERT®.
Tell your doctor if you are taking any supplements or herbal preparations.


Remeber, even docs have a boss...

There is evidence of testing the triptan mixing with successful results.  There is also more evidence of the quote above.  Then, there are the personal stories about the subject.

No one here can stop anyone from doing this.  All we can do is offer up the info and the warning.

Chris
Title: Re: Mixing triptans
Post by alleyoop on Jul 11th, 2004, 11:44am
Well Put Chris!



...............................alley
Title: Re: Mixing triptans
Post by catlind on Jul 12th, 2004, 9:55am
As a side note, Roxy had NO history of cardiac trouble whatsoever.  

If not for yourself, think about your family.  I was the one that called the ambulance.  Then had to call her husband.  

There's no question that T's end of it was far more terrifying than mine, but having to sit beside her and pray with everything I had that she would be ok, to sit in the hospital beside her wondering if I would be the last one to see her alive, and how on earth was I going to tell her husband.

This is not something to take lightly.  Roxy came as close as you can come and still survive.  Listen to her, it's not worth your life.

Cat
Title: Re: Mixing triptans
Post by alleyoop on Jul 12th, 2004, 10:08am
Roxy, Cat, thanks for the testimonials. No way you'll ever catch me mixing triptans, no matter how bad the pain. What gets me is despite the documented danger of doing this, apparantly there are MDs out there advising that it is OK! Thank God, my neuro is not one of them or I may not be talking to you right now!




................................alley


ps
Cat, did you get my email?
Title: Re: Mixing triptans
Post by Prense on Jul 12th, 2004, 10:51am
In case you didn't know...


Quote:
Ginkgo biloba, ginseng, echinacea, St. John's wort and large quantities of garlic can interact with migraine medications -- including triptans -- used to treat migraine pain, and tricyclic antidepressants, which are used to prevent migraines, the researchers report.

These herbs can interact with liver enzymes that metabolize the two migraine medications, which can cause a toxic interaction, says researcher Carla Rubingh, a clinical pharmacist specializing in headache and pain management at the Utah Health Sciences Center.

The reaction could be fatal with the combination of a tricyclic antidepressant and St. John's wort, the researchers say.


http://health.discovery.com/news/healthscout/article.jsp?aid=513780&tid=12

Chris
Title: Re: Mixing triptans
Post by Prense on Jul 12th, 2004, 10:54am

on 07/12/04 at 10:08:54, alleyoop wrote:
What gets me is despite the documented danger of doing this, apparantly there are MDs out there advising that it is OK! Thank God, my neuro is not one of them or I may not be talking to you right now!


Here's why...


Quote:
Sequential Use of Triptans
Even though it is not recommended by the manufacturers, in clinical practice, one may combine a rapid acting triptan preparation such as sumatriptan injection or nasal spray followed by a longer acting oral tablet such as naratriptan. These kind of combinations have reduced the length of headache, reduced recurrence and also helped to cut down the total number of triptan doses taken by the patients.47


http://www.clusterheadaches.org/library/medications/triptans.htm

I would be interested in finding clinical studies on this.

I was very surprised to find this on the OUCH site...

Chris
Title: Re: Mixing triptans
Post by Roxy on Jul 12th, 2004, 7:46pm
Isn't that just what I did?  Mix an injection with a longer acting oral tablet?  

That advice just scares me.... :o
Title: Re: Mixing triptans
Post by Prense on Jul 12th, 2004, 8:44pm

on 07/12/04 at 19:46:13, Roxy wrote:
Isn't that just what I did?  Mix an injection with a longer acting oral tablet?  

That advice just scares me.... :o


In my search on the subject, that was the one link that discussed mixing different triptans.  Other links reported on using imitrex tablet and injections or NS at close intervals for treating acute migraine attacks.


Quote:
What strategy did Dr. Kaniecki assess in his interesting report? At first glance, it appears that most patients used a step-care-within-attack approach, with subcutaneous sumatriptan used after treating with oral or intranasal formulations of sumatriptan. However, patients also had the option of using subcutaneous sumatriptan as the initial treatment. This distinction is important in that it gives the patient a choice of initial therapy. It is useful to distinguish between patient-centered stratified care and other stratified care strategies. Patient-centered stratified care is a treatment approach that warrants further study using a broad range of treatment options and appropriate control groups.


http://www.headachedrugs.com/archives/mixing_sumatriptan.html

Again, I was shocked to find an article about mixing different triptans on the OUCH site, even with the opening disclaimer.

Chris
Title: Re: Mixing triptans
Post by catlind on Jul 12th, 2004, 10:40pm
I would say that the bottom line is to discuss your medications and any concerns with your doctor, and if they aren't aware of the dangers of mixing triptans, or feel that it isn't a danger, ask them why they feel it is safe for your particular case.

As with every medication we deal with, each of us reacts differently, and the final word should be your doctors -- IF you trust your doctor.  I've learned the hard way not to blindly trust a doctor when it comes to medication.  

Secondly, doctors know a great deal about conditions, but I've learned they actually know very little about medications.  Discuss concerns with your pharmacist as well, their sole job is to know medications.  

Use your own resources and the resources of ALL the members of your medical care team.

As a general rule, do NOT mix triptans, that is the advice I would give.

Cat


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